Myocardial infarction following fast-track total hip and knee arthroplasty-incidence, time course, and risk factors: a prospective cohort study of 24,862 procedures

TY - JOUR

T1 - Myocardial infarction following fast-track total hip and knee arthroplasty-incidence, time course, and risk factors

T2 - a prospective cohort study of 24,862 procedures

AU - Petersen, Pelle B

AU - Kehlet, Henrik

AU - Jørgensen, Christoffer C

AU - Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group

PY - 2018/11/2

Y1 - 2018/11/2

N2 - Background and purpose - Acute myocardial infarction (MI) is a leading cause of mortality following total hip and knee arthroplasty (THA/TKA). The reported 30-day incidence of MI varies from 0.3% to 0.9%. However, most data derive from administration and insurance databases or large RCTs with potential confounding factors. We studied the incidence of and potential modifiable risk factors for postoperative MI in a large, multicenter optimized "fast-track" THA/TKA setting. Patients and methods - A prospective cohort study was conducted on consecutive unselected elective primary unilateral THA and TKA, using prospective information on comorbidities and complete 90-day follow-up from the Danish National Patient Registry. Evaluation of discharge summaries and medical records was undertaken in cases of suspected MI. Logistic regression analyses were carried out for identification of preoperative risk factors. Results - Of 24,862 procedures with a median length of stay 2 (IQR 2-3) days, 30- and 90-day incidence of MI was 31 (0.12%) and 48 (0.19%). Preoperative risk factors for MI ≤30 days were age >85 years (OR 7.4, 95% CI 2.3-24), insulin-dependent diabetes mellitus (IDDM) (3.6, CI 1.1-12), cardiovascular disease (2.4, CI 1.1-5.0) and hypercholesterolemia (2.3, CI 1.1-5.1). Of 31 patients with MI ≤30 days 9 were treated with vasopressors for intraoperative hypotension and 27 had postoperative anemia. Interpretation - Fast-track THA and TKA had a low 30-day MI incidence. Focus on patients with age >85, IDDM, cardiovascular disease, and hypercholesterolemia may further reduce the 30-day incidence of MI. The role of postoperative anemia and intraoperative hypotension are other areas for further improvement.

AB - Background and purpose - Acute myocardial infarction (MI) is a leading cause of mortality following total hip and knee arthroplasty (THA/TKA). The reported 30-day incidence of MI varies from 0.3% to 0.9%. However, most data derive from administration and insurance databases or large RCTs with potential confounding factors. We studied the incidence of and potential modifiable risk factors for postoperative MI in a large, multicenter optimized "fast-track" THA/TKA setting. Patients and methods - A prospective cohort study was conducted on consecutive unselected elective primary unilateral THA and TKA, using prospective information on comorbidities and complete 90-day follow-up from the Danish National Patient Registry. Evaluation of discharge summaries and medical records was undertaken in cases of suspected MI. Logistic regression analyses were carried out for identification of preoperative risk factors. Results - Of 24,862 procedures with a median length of stay 2 (IQR 2-3) days, 30- and 90-day incidence of MI was 31 (0.12%) and 48 (0.19%). Preoperative risk factors for MI ≤30 days were age >85 years (OR 7.4, 95% CI 2.3-24), insulin-dependent diabetes mellitus (IDDM) (3.6, CI 1.1-12), cardiovascular disease (2.4, CI 1.1-5.0) and hypercholesterolemia (2.3, CI 1.1-5.1). Of 31 patients with MI ≤30 days 9 were treated with vasopressors for intraoperative hypotension and 27 had postoperative anemia. Interpretation - Fast-track THA and TKA had a low 30-day MI incidence. Focus on patients with age >85, IDDM, cardiovascular disease, and hypercholesterolemia may further reduce the 30-day incidence of MI. The role of postoperative anemia and intraoperative hypotension are other areas for further improvement.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Hip/adverse effects

KW - Arthroplasty, Replacement, Knee/adverse effects

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Incidence

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/epidemiology

KW - Patient Readmission/statistics & numerical data

KW - Postoperative Complications/etiology

KW - Prospective Studies

KW - Recovery of Function

KW - Registries

KW - Risk Factors

U2 - 10.1080/17453674.2018.1517487

DO - 10.1080/17453674.2018.1517487

M3 - Journal article

C2 - 30326755

SN - 1745-3674

VL - 89

SP - 603

EP - 609

JO - Acta Orthopaedica

JF - Acta Orthopaedica

IS - 6

ER -